HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST 8E CONIPi7; �LA•�N TO BE ACCEPTED
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Date: �b• e n �y �l ` ' Permit Number: r ��
OCT 2 8 X016
s j` . Lucie County
PERFJiITTiNG
BLffidi Mil'hit Appli��tlbW`g Department
Planning and Development Services hate: p �....:.•� -
Building and Code Regulation Division Approved y•.
230.0 Virginia Avenue,Fort Pierce FL 34982 pp �• '��" `��°'
Phone: (772)462-1553 Fax: (772)462-1578 CommerciaA,FpQMA �Al lam'
PERMIT APPLICATION FOR: To Select from dropbox, clic ow U -Ka t e en oIne
PRC�P+OSED l.lb!!"PRG)UENIiNT LCCATI0;1i.
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Address: 21 n4 k e V
`ro
14 Legal Description: ITkT-go Tt�L � s�j ({� F�
PropertyTaxlD#:�°'4�� - `�i'67- Oo 5f - Ooo 6 Lot No.
Site Plan Name:SO k�e Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DEF77777TAILED DESCRIPTLON CSF WORK -
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CONSTRU,CT,j N],'NF0,R,'M AKT.-IO;N-
Additional work to be performed
under this permit-c ec all Mg appy: .
❑HVAC Gas Tank Gas Piping _Shutters Windows/Doors
❑Electric ❑ Plumbing Sprinklers 1:1 Generator E] Roof Roof pitch
Total Sq. Ft of Construction: -A 4 Z Sq. Ft. of First Floor: 2A
Cost of Construction:$ g,�a Utilities:�Sewer SSeptic Building Height:
ovuNR/EE
ssE c��TAoR:
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Name Olive- ze) Name: H or-I k a ( GJ&
Address: 2 10 q IJ ucL Com pany: Z
City: f G1yy E%eeas State:VL Address:3 34 15W 6.o §L C_> ----- '7v
Zip Code: Fax: City:fa i 'GA V-WAx`e State: K-
Phone No. _ Zip Code: 130(511 Fax: c�k
E-Mail:_V) Phone No.9�:)2- 5fq� ?- 44q
Fill in fee simple Title Holder on next page.(if different E-Mail• 0W_cow W5 cok
rfrorn t'he.Owner ls'ted above) State)or)Couunty License: Gi_ 15 1 5 4 1
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
®p e 6 m3 'a) pxa v
Sl!'PP EMENTA�.CONSTR D�110N LIEN LAfillir I;�1F€ RMATION
DESIGNER/ENGINEER: Not A licable
MORTGAGEIOMPANY: Applicable
Name: & 9 Name:
Address: Address:
City: State: City: State:
Zip: Phon . Zip: Phone:
FEESIMPLE TI LE HOLDER: Mb Applicable BONDING C MPANY: ---'ITot Applicable
Name: Name:
Address: Address:
City: City:
Zip: p tare.: zip .krone: _
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans,the Florida Building Codes and St. Lucie County Amendments.
The foflouving building parmit applications are exempt from,undergaing a full concurrency;review:Too M, additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property.A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording your
Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF LJ Ci e COUNTY OF lr_
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of Q�br 20 JA.Qby this day of 020 AA—P by
, e_t( k fa"z W&4-,y 0 P.n r-%�. -Pe/ H&_r�ei
(Name of person acknowledging) (Name of person acknowledging)
(Signature of NotA Public-State of Florida) (Signature of NotarV Public-State of Florida)
Personally Known OR Produced Identification Personally Known V OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. off; Jp�y��Sea1) JENNIFER IlA om ission No. a'01"ty ('4, (Seal) j1hNIfN HpNC
Notary PuGlle =91010 of WIN ,�' Netafy f3uUhe=§i�fe di�ISf
:
•;`�+,� r my Comm. Expift5 Jan py, Ago ,���Fo.�,;ar°� My Cutiiffi Eiip'iies j1H 2U.20 0
��''��::� 1 sa """" Bnndedtfiwou h
Revised 07/15/2014 Bonded fpioGq�gfiljoflg N61iti' Rss�i. e'^rational rVoiary at
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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